AB0710 MIXED RESPONSE TO TOFACITINIB IN INDIAN PATIENTS WITH REFRACTORY TAKAYASU ARTERITIS: A MULTI-CENTER STUDY
Authors: R. Goel, P. Vasanth, S. Padiyaru, R. Aithala, A. Patil, A. Jain, B. Pinto, R. Jois, J. Mathew, D. Danda, G. Joseph
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Treatment of patients with Takayasu arteritis (TAK) is challenging in-spite of the use of conventional cytotoxic agents and biologics. Tofacitinib has been reported to be effective in inducing and maintaining remission in around 80% of patients with refractory TAK [1]. <h3>Objectives</h3> To assess the efficacy and safety of tofacitinib in Indian patients with TAK. <h3>Methods</h3> In this retrospective study, medical records of consecutive patients with TAK being treated with either originator or generic tofacitinib at 4 centres in India were studied. Details regarding demographics, clinical presentation, disease duration, Indian Takayasu Activity score (ITAS), laboratory markers angiography treatment and response to treatment were recorded. The disease was considered active if the patient had evidence of activity in any two of the following three domains: new clinical symptoms as evidenced by ITAS &gt;1; persistently raised C-reactive protein (CRP) for 2 consecutive visits; new areas of arterial wall thickening or active uptake in angiography or 18FDG PETCT respectively. Good response was defined as the absence of activity in at least 2 of the 3 above-mentioned domains. In contrast, presence of carotidynia or new areas of arterial narrowing were considered as standalone indicators of disease activity. In the absence of follow up imaging, a rise in CRP from baseline visit on 2 consecutive occasions was also considered as active disease. The data is presented as mean± SD or median (Interquartile range) according to distribution of data. Fischer's exact test or Mann Whitney test was used to compare the parameters between patients with good response and no response to treatment. <h3>Results</h3> Twenty-seven patients (24, 88.9% females; age 30.4 ± 8.13 years) with median disease duration 48 (20-72) months were included. At diagnosis, 13 (48.1%), 6 (22.2%), 15 (55.6%) and 7 (25.9%) patients presented with constitutional symptoms, carotidynia, ischemia features and aortic regurgitation respectively. All patients had active disease while all except 1, had received a median of 3 (1-4) lines of immunosuppressants including biologics in 16 (59.3%). All patients received prior systemic steroids. The indication of switching to tofacitinib were clinical, laboratory and imaging wise activity in 19, 17 and 4 patients respectively. The median ESR, CRP, ITAS score and steroid dose at initiation of tofacitinib was 46 (25-72) mm/1<sup>st</sup> hr, 25 (16.5-44) mg/L, 0 (0-2) and 7.5 (5-10) mg/day respectively. At median follow up of 10 (5-12) months, clinically stable disease was observed in 18 (72%), normalisation of CRP in 9 (36%), decrease in CRP in 8 (32%) and non-progression of new lesions in angiography (available in 10 patients) in 8 patients. Overall, 14 (51.9%) had good response in 2 domains and were classified as responders. The responders trended to have significantly higher median disease duration as compared with non-responders (median: 60 (41-96) months vs 27 (6-63) months), p= 0.054. None of the other clinical parameters differentiated the two groups. Four patients discontinued the drug due to side effects while one patient had sudden death within 3 months of initiation on tofacitinib. <h3>Conclusion</h3> The response to tofacitinib was modest in Indian patients with difficult to treat TAK. Further multi-ethnic studies are required to ascertain its effectiveness in TAK. <h3>References</h3> [1]Kong X, Sun Y, Dai X, Wang L, Ji Z, Chen H, Jin X, Ma L, Jiang L. Treatment efficacy and safety of tofacitinib versus methotrexate in Takayasu arteritis: a prospective observational study. Ann Rheum Dis. 2022 Jan;81(1):117-123. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.